Botox injections into the muscles of the forehead, head and neck have been in clinical trials over the last few years to see if they are able to prevent migraine in people who suffer from chronic migraines. After the results were published in May, drug regulators in the UK decided that the evidence was strong enough to enable this treatment to be approved. Patients diagnosed with chronic migraine will now be eligible for Botox treatment, which officially became available for this indication in July 2010.
How is Chronic Migraine Defined?
Botox injections are intended as a treatment that prevents migraines, rather than treating the pain of an acute attack. To be able to benefit from the treatment, patients must fit within some fairly strict criteria. Only people with chronic migraine are suitable and this condition is defined as having headaches on at least 15 days in each calendar month; half of those headache days must involve migraine symptoms as well as head pain.
Many people get migraines once or twice a month, but those with chronic migraine can get them at least every other day. This can be very disabling – in fact, the World Health Organisation recognises migraine as one of the most disabling health conditions that anyone can have. It’s on a par with types of paralysis in terms of its impact on quality of life.
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The clinical trials followed 1300 people who were diagnosed with chronic migraine and who had been keeping migraine diaries for weeks or even months before the trial started. They were then given a course of Botox injections in the muscles of the head and neck once every 12 weeks. Each treatment involved several injections. After six months, the frequency of headaches in the treated group was significantly lower than in the sham injection group. After a year of treatment, around 70 per cent of the treated patients only experienced half the headaches that they used to.
The impact of this preventive treatment on the lives of those with chronic migraine could be massive. Even if the frequency of the migraines is reduced by half, that means that people could gain up to 10 more headache free days each month, and might also be able to reduce their use of the standard pain killers. People with chronic migraine are at high risk of overusing these medications, causing their headaches to progress and become more or less constant.
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How is the Botox Treatment Given?
Before a patient can be considered for Botox treatment, they must keep a headache diary so that their condition can be diagnosed. This is usually done by a neurologist, rather than a GP so it is important to see your GP first if you think your migraine headaches are affecting your quality of life. Managing triggers, using painkillers more effectively and using prescription drugs such as triptans can all help but many people with migraine never get this opportunity because they suffer in silence, thinking that nothing can be done.
Once someone is given the diagnosis of chronic migraine, the Botox treatment is given every 12 weeks and the injections must be placed very precisely by a neurologist who has been trained in the technique. The injections are slightly uncomfortable but this is an outpatient procedure and there are usually no ill-effects afterwards. The clinical trials have shown the treatment to be very safe compared to some of the drugs that used to be used to treat migraines.
How Does Botox Treatment for Migraine Work?
The exact mechanisms are not completely understood but the botulinum toxin in the treatments relaxes the muscles in the head and neck. This reduces tension that can trigger migraines. Botox also seems to block some of the nerve signals that build up at the very start of a migraine, nipping the headache attack in the bud.
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